Totally Endoscopic Transaortic Septal Myectomy for Hypertrophic Cardiomyopathy

This video demonstrates a totally endoscopic transaortic extended septal myectomy for obstructive hypertrophic cardiomyopathy in an 81-year-old woman who was heavily symptomatic with class 3 shortness of breath. The LVOT peak gradient was measured 132 mm Hg on TOE. The authors used a totally endoscopic approach through a 3 cm, 2nd intercostal space (ICS), right parasternal working incision, a 10 mm port for the 3D 30-degree endoscope in the same ICS, and two stab wounds, one for the Chitwood clamp in the 1st ICS and one for the atrial vent in the 5th ICS anterior axillary line. This set up was the same with the one described by this group previously on CTSNet and elsewhere for totally endoscopic aortic valve surgery and totally endoscopic transaortic mitral valve repair (1-4). The authors used a metal net to spread and protect the normal aortic valve leaflets and four traction sutures to retract the basal septum. The myectomy was performed according to the principles presented by the Mayo Clinic group (5). Postoperative TOE revealed a widely open LVOT with a peak gradient of 11.2 mm Hg. The patient had an uneventful recovery and remains entirely asymptomatic six months postoperatively.

References

1. Pitsis A, Tsotsolis N, Nikoloudakis N, Kelpis T, Economopoulos V, Keremidis I. Totally Endoscopic Aortic Valve Replacement With a Trifecta GT Bovine Pericardial Valve. CTSNet. August 2019. doi:10.25373/ctsnet.9587900.
2. Pitsis A, Tsotsolis N, Nikoloudakis N, Kelpis T, Economopoulos V, Keremidis I, et al.. Totally Endoscopic Aortic Valve Replacement Using an Automated Annular Suturing Device. CTSNet. March 2020. doi:10.25373/ctsnet.12024627
3. Pitsis A, Tsotsolis N, Nikoloudakis N, Keremidis I, Boudoulas H, Boudoulas KD. Totally Endoscopic Aortic Valve Replacement and Transaortic Mitral Valve Repair. CTSNet. February 2020. doi:10.25373/ctsnet.11689443.
4. Pitsis A, Boudoulas C, Boudoulas KD. Operative steps of totally endoscopic aortic valve replacement, Interact Cardiovasc Thorac Surg. September 2020;31(3):424.
5. Kotkar KD, Said SM, Dearani JA, Schaff HV. Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience. Ann Cardiothorac Surg. 2017;6(4):329-336.

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